DNA and serumbank for patients with an initial episode of chestpain.

An important aspect when treating patients with chestpain is the identification
of riskfactors for coronary heart disease (CHD). The overall riskprofile
determines the diagnostic evaluation of patients with chestpain. In highrisk
patiets, rapid invasive evaluation is recommended, compared to non-invasive
evaluation in low-risk patients. In patients with an intermediate risk of CHD
the ideal diagnostic work-up is unknown and often too much or too few
diagnostic tests are performed. The overall cardiovascular risk profile affects
the choice of treatment as well. Treatment of traditional risk factors such as
hypertension and hypercholesterolemia reduces morbidity and mortality in
patients with and without CHD.

Many riskfactors have been identified, but it remains difficult to determine
the individual risk of CHD. Apperently, there are more, not yet identified risk
factors that contribute to CHD. Identification of these riskfactors may
contribute to guiding the prevention, diagnosis and treatment of CHD.

Medical and invasive therapy in CHD used for the entire patient population,
whereas it is likely that there are important inter-individual differences
between patients that determine the succes of a certain treatment. The use of
existing knowledge in famacogenetis and the identification of novel gentic and
biochemical parameters may determine a more rational therapy in individual
patients.

The department of cardiology has initiated a new project (MISSION Chestpain).
In this project, patients with chestpain without a history of CHD, are being
analyzed using a standard diagnostic protocol according to the general
guidelines/ standards using standard an state of the art diagnostic tests. This
protocol is primarily developed to improve the quality of patientcare in the
LUMC.

For identification of novel riskfactors and genetic markers, it is important to
collect biologic material in a database. This material include DNA and serum,
derived from peripheral whole blood. DNA is important because novel genetic
markers are being determined. Serum is important because all known current
riskfactors are proteins that can be determined in serum.

Identification of genetic and biochemical riskfactors for CHD in patiente with
chestpain. The identification of (genetic and biochemical) markers that
determine the efficacy of a medical or invasive therapy in these patients.

All patients, referred to the outpatient cardiology clinic, and presenting with
symptoms of chestpain are eligible. These patients will be diagnosed and
treated according to a standard diagnostic protocol, using state of the art
imaging techniques such as Echo-doppler, Multislice coronary CT and myocardial
perfusion scintigraphy.

The patients will be informed by their cardiologist about the DNA study, both
written and orally. After signiing the informed consent form, the patient can
be referred to a nurse for bloodtests. In total 4 vials (3 EDTA and 1 Gel) of
7 cc wholeblood will be obtained by a nurse, and be sent to the cardiology
laboratory. DNA, serum ansd plasma will there be isolated and stored.

None.